糖尿病足感染病原菌及其耐药性和分子特征

Distribution,drug resistance and molecular characteristics of pathogens isolated from patients with diabetic foot infection

目的分析糖尿病足感染(DFI)足部分泌物中的病原菌、耐药性及分子特征。方法收集2019年8月-2020年8月汉川市人民医院内分泌科收治的135例DFI患者足部分泌物,使用Phoenix 100全自动细菌鉴定/药敏系统配合配套药敏试验板进行病原菌药敏试验,提取细菌DNA,采用多位点序列分型(MLST)或细菌基因组重复序列PCR技术(ERIC-PCR)进行分子分型。结果135例DFI患者足部分泌物分离出菌株共228株,革兰阳性菌总计88株(38.60%),以金黄色葡萄球菌、粪肠球菌为主;革兰阴性菌总计136株(59.65%),以变形杆菌、大肠埃希菌为主。革兰阳性菌中敏感药物主要为万古霉素、利奈唑胺、奎奴普丁-达福普汀、替考拉宁,革兰阴性菌中敏感药物主要为哌拉西林-他唑巴坦、亚胺培南、美罗培南。36株变形杆菌进行ERIC-PCR分型,其中Ⅰ型11株、Ⅱ型6株、Ⅲ型8株、Ⅳ型11株;30株大肠埃希菌菌株中有22株成功进行MLST分型,从高到低分别为ST94、ST6010、ST226、ST6005、ST69、ST6006;26株金黄色葡萄球菌菌株中有20株成功进行MLST分型,从高到低分别为ST59、ST630、ST88、ST188、ST6。结论变形杆菌Ⅰ型和Ⅳ型、大肠埃希菌ST94和ST6010、金黄色葡萄球菌ST59和ST630是DFI分泌物中常见病原菌类型,临床应当重视其耐药模式。

OBJECTIVE To investigate the drug resistance and molecular characteristics of pathogens isolated from foot secretions of patients with diabetic foot infection(DFI).METHODS The foot secretions were collected from 135 patients with DFI who were treated in endocrinology department of Hanchuan People′s Hospital form Aug 2019 to Aug 2020,the drug susceptibility testing was carried out for the pathogens by using Phoenix 100 automatic bacterial identification/drug susceptibility test board with supporting drug susceptibility system.The DNA of the pathogens was extracted,and molecular typing was performed by multilocus sequence typing(MLST)or enterobacterial repetitive intergenic consensus-polymerase chain reaction(ERIC-PCR).RESULTS Totally 228 strains of pathogens were isolated from foot secretions of the 135 patients with DFI,88(38.60%)of which were gram-positive bacteria,136(59.65%)were gram-negative bacteria;Staphylococcus aureus and Enterococcus faecalis were the predominant species of the gram-positive bacteria;Proteus and Escherichia coli were dominant among the gram-negative bacteria.The gram-positive bacteria were mainly sensitive to vancomycin,linezolid,quinupristin-dalfopristin and teicoplanin;the gram-negative bacteria were mainly sensitive to piperacillin-tazobactam,imipenem and meropenem.The result of ERIC-PCR typing showed that among the 36 strains of Proteus,there were 11 strains of typeⅠ,6 strains of typeⅡ,8 strains of typeⅢand 11 strains of typeⅣ.MLST was carried out successfully for 22 of 30 E.coli isolates,the order of ST from high to low was as the following:ST94,ST6010,ST226,ST6005,ST69 and ST6006.MLST was carried out successfully for 20 of 26 S.aureus isolates,and the order of ST from high to low was as follow:ST59,ST630,ST88,ST188 and ST6.CONCLUSION TypeⅠandⅣProteus,ST94 and ST6010 E.coli,and ST59 and ST630 S.aureus are the common species of pathogens isolated from the foot secretions of the patients with DFI.It is necessary for the hospital to pay attention to the drug resistance patterns.